Response of large and small coronary arteries of pigs to intracoronary injection of acetylcholine: angiographic and histologic analysis

Innervation of the coronary arteries and its role in controlling microvascular resistance

The coronary circulation plays a crucial role in balancing myocardial perfusion and oxygen demand to prevent myocardial ischemia. Extravascular compressive forces, coronary perfusion pressure, and microvascular resistance are involved to regulate coronary blood flow throughout the cardiac cycle. Autoregulation of the coronary blood flow through dynamic adjustment of microvascular resistance is maintained by complex interactions among mechanical, endothelial, metabolic, neural, and hormonal mechanisms. This review focuses on the neural mechanism. Anatomy and physiology of the coronary arterial innervation have been extensively investigated using animal models. However, findings in the animal heart have limited applicability to the human heart as cardiac innervation is generally highly variable among species. So far, limited data are available on the human coronary artery innervation, rendering multiple questions unresolved. Recently, the clinical entity of ischemia with non-obstructive coronary arteries has been proposed, characterized by microvascular dysfunction involving abnormal vasoconstriction and impaired vasodilation. Thus, measurement of microvascular resistance has become a standard diagnostic for patients without significant stenosis in the epicardial coronary arteries. Neural mechanism is likely to play a pivotal role, supported by the efficacy of cardiac sympathetic denervation to control symptoms in patients with angina. Therefore, understanding the coronary artery innervation and control of microvascular resistance of the human heart is increasingly important for cardiologists for diagnosis and to select appropriate therapeutic options. Advancement in this field can lead to innovations in diagnostic and therapeutic approaches for coronary artery diseases.

Effect of N-epsilon-(carboxymethyl)lysine on coronary vasoconstriction in isolated perfused hearts from control and streptozotocin-induced diabetic rats

Advanced glycation end products (AGEs) derived from glucose are implicated in the pathogenesis of diabetic vascular disease. However, their direct modulatory effects on coronary vascular tone remain unclear. We previously reported that coronary vasoconstriction was induced by acetylcholine (ACh) infusion of the isolated perfused rat heart and that sensitivity was greater in perfused hearts from streptozotocin (STZ)-induced diabetic rats than in those from age-matched controls (Kamata et al., 2008). Here, we investigated the effect of N(epsilon)-(carboxymethyl)lysine (CML), which has one of the main AGE structures, on ACh-induced vasoconstriction in perfused hearts isolated from control and diabetic rats. ACh-induced vasoconstriction was significantly greater in the STZ-induced diabetic group than in the age-matched controls. CML enhanced the ACh-induced vasoconstriction in coronary arteries from control rats, but not in those from STZ-induced diabetic rats. In the controls, the vasoconstriction induced by the calcium-channel activator Bay K 8644 was also enhanced by CML. These CML-mediated enhancements of the vasoconstrictions induced by ACh and Bay K 8644 were significantly suppressed by tempol, a superoxide dismutase mimetic. The plasma CML and glucose levels were each significantly elevated in STZ-induced diabetic rats. These findings suggest (a) that CML augments ACh-induced coronary vasoconstriction, an effect that may be attributable to increased superoxide and to activation of voltage-gated Ca(2+) channels and (b) that this modulating effect may be desensitized in the STZ-induced diabetic heart.

Acute cellular damage in medial smooth muscle cells following experimental coronary angioplasty in dog. Damage of cytoskeleton and apoptosis

The purpose of the present study was to investigate the responses of the cytoskeleton and the presence of apoptosis following acute damage of medial smooth muscle cells after percutaneous transluminal coronary angioplasty (PTCA). We killed 20 dogs, 4h and 4 days after PTCA (n=10 in each group). Ten dogs without PTCA were used as controls. PTCA was achieved by inflating balloon catheters two times, for 60s each time, to 150 PSI, followed by a 60-s deflation. The coronary artery obtained from each dog was fixed in 10% formalin neutral buffer solution. The response of the cytoskeleton was studied immunohistochemically. using monoclonal antibodies against alpha-smooth muscle actin, vimentin, and beta-tubulin. Proliferation was determined by proliferating cell nuclear antigen (PCNA), and DNA fragmentation indicating apoptosis was determined by in situ nick end labeling. Four h after PTCA, endothelial denudation, microscopic mural thrombi, rupture of the internal elastic membrane, medial tear, and stretched smooth muscle cells with nuclei were found at the PTCA site. An immunohistochemical study revealed diffuse reduction or defective immunoreactivity in each cytoskeleton of medial smooth muscle cells, 4h after PTCA. The extent of positive immunoreactivity in the media decreased to 45+/-11% in alpha-smooth muscle actin (control value, 80+/-10%), 9+/-8% in vimentin (control value, 83+/-9%), and 10+/-7% in beta-tubulin (control value, 75+/-8%). The decrease was more significant in vimentin and beta-tubulin than in alpha-smooth muscle actin. Four days after PTCA, the features were diffuse cell death and the focal proliferation of medial cells, as well as macroscopic intramural thrombi. The extent of positive immunoreactivity in the media was 15+/-9% in alpha-smooth muscle actin, 13+/-7% in vimentin, and 14+/-11% in beta-tubulin. There were no smooth muscle cells with positive PCNA (0%) in the control and 4-h groups, but 4 days after PTCA the percentage was 19+/-4%. In situ nick end labeling showed DNA fragmentation in the nuclei of medial smooth muscle cells at a rate of 15+/-5% 4h after PTCA and at 8+/-6% 4 days after PTCA, compared with 0% in the control. We concluded that severe damage of the cytoskeleton and medial smooth muscle cell death were induced immediately after PTCA, followed by proliferation of smooth muscle cells. Apoptosis may be partially involved in the death of smooth muscle cells, in addition to necrosis. Damage to the cytoskeleton and apoptosis may play an important role in the pathogenesis of acute lesions and the proliferation of smooth muscle cells after PTCA.

Opposing actions of cholinergic agonist and trinitroglycerin on net vascular resistance in perfused rat heart

The effects of cholinergic agonist and nitrovasodilator on transorgan pressure-flow relationships were characterized under antegrade aortic perfusion of the rat heart. Under basal conditions, the preparation exhibited a stable linear dependence of perfusion pressure upon regulated transorgan flow rate from 0 to 9 ml/min with a transorgan vascular resistance of 5 +/- 0.6 mmHg/ml per min. Maximal acetyl-beta-methacholine (10 microM) caused a 3-fold increase in net transorgan vascular resistance to flow of non-cellular perfusate as observed over the range of constant flow rates from 1 to 8 ml/min. Trinitroglycerin (20 microM) reversed cholinergic-induced vasoconstriction. The effects of acetylcholine on transorgan flow were characterized at constant perfusion pressures approximating mean aortic pressures under lethal hypotension (40 mmHg), sublethal hypotension (70 mmHg) and normotension (100 mmHg). Under maximal acetylcholine (5 microM), flow remained adequate at 4.6 ml/min under 100 mmHg aortic pressure, marginally adequate at 1.2 ml/min under 70 mmHg, and sublethally inadequate at 0.4 ml/min under 40 mmHg. It is concluded that acetylcholine is among the factors increasing vascular resistance that can be opposed by nitrovasodilator. It is estimated that inadequate flow might result from maximal cholinergic agonist under hypotensive but apparently not normotensive aortic perfusion pressure as observed in hearts from normal animals.

Heterogeneity of muscarinic receptors in lamb isolated coronary resistance arteries

1. In vitro experiments in a microvascular myograph were designed to characterize postjunctional muscarinic receptors producing contraction both in the presence and absence of the endothelium in coronary resistance arteries (normalized diameter of 150-450 microns), isolated from the left ventricle of hearts from 3-6 month old lambs. Preferential muscarinic receptor antagonists were used to determine the receptor subtype: pirenzepine (M1 receptor), AFDX 116 (M2 receptor), 4-DAMP and pFHHSiD (M3 receptor). 2. The rank order of potency for muscarinic agonist-induced increases in tension in endothelium-intact preparations was oxotremorine-M = methacholine = acetylcholine (ACh) > carbachol. Removal of the endothelium increased the potency of ACh, but this procedure did not change either the sensitivity or maximal response to carbachol. 3. The contractile response to ACh was reproducible. Incubation with 3 x 10(-7)-3 x 10(-6) M pirenzepine induced non-parallel rightward shifts and depressed the maximum of the concentration-response curve to ACh in endothelium-intact arteries. The slope by Schild analysis was 2.9 +/- 0.8 (P < 0.05, n = 7). Atropine, AFDX 116, 4-DAMP and pFHHSiD produced parallel rightward shifts of the curves to ACh and the slopes of the Schild plots were not significantly different from unity. The pKB values for the antagonists from plots constrained to unity in endothelium-intact segments were: atropine (9.4), 4-DAMP (9.0), pFHHSiD (7.9) and AFDX 116 (6.2). 4. In endothelium-denuded arteries, pirenzepine, AFDX 116 and pFHHSiD caused concentration-dependent, parallel rightward displacements of the concentration-response curves to ACh and the slopes of the Schild plots were not significantly different from unity. The plots constrained to a slope of unity gave the following pKB values: pFHHSiD (8.7), pirenzepine (7.5) and AFDX 116 (6.2). 5. In the presence of the endothelium, low concentrations of pirenzepine (10(-9)-10(-7) M) produced leftward shifts of the ACh concentration-response curves. This potentiating effect of pirenzepine was reversed by endothelial cell removal. In preparations precontracted with the thromboxane-mimetic, U46619, the putative M1-selective agonist, McN-A-343, induced a biphasic relaxation with log IC50 of 8.53 +/- 0.14 and 5.02 +/- 0.08 for the first and second phase of the relaxation, respectively, and maximal relaxations of 22.8 +/- 4.3% and 41.1 +/- 5.4% (n = 16). McN-A-343 relaxed the vessels in the presence of 10(-7) M pFHHSiD and 3 x 10(-7) M AFDX 116, but not after incubation with 10(-9) M pirenzepine. 6. It is concluded from the pKB values for the antagonists used, that contraction induced by ACh in lamb coronary resistance arteries, in either the presence or the absence of the endothelium, is mediated via the M3 subtype of muscarinic receptors, while muscarinic receptors of another subtype at the endothelium seem to modulate the contractile response to ACh.